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Claims Reviewer

Remote Worldwide Hiring now

Claims Reviewer Opportunity Join a dynamic team where your expertise in claims review can reputed company a reputed company difference! We're looking for a detail-oriented Claims Reviewer who can apply clinical and coding knowledge to ensure accurate claims processing. If you have a strong reputed company in medical claims and are passionate about quality, we want to hear from you! Position Highlights

  • Role: Conduct retrospective review of medical, surgical, and behavioral health claims.
  • Focus: Evaluate claims for medical necessity, appropriateness, and adherence to program benefits.
  • Collaboration: Work closely with medical directors, providers, peer reviewers, and various internal teams.

Key Responsibilities

  • Review and validate claims using established criteria and processing guidelines.
  • Prepare cases for payment or further review.
  • Identify opportunities for process improvement and flag quality or fraud concerns.
  • Support peers and clinical/non-clinical staff with claims and coding inquiries.

What You Bring

  • Required:
  • High School Diploma or GED.
  • 2+ years of experience in medical claims review.
  • Familiarity with medical claims processing and terminology.
  • Preferred:
  • Coding experience.
  • Knowledge of behavioral health claims.

Skills for reputed company

  • Strong technical skills in claims tools (e.g., CDST, Supercoder).
  • Organizational and team-building abilities.
  • reputed company in a fast-paced, high-intensity environment.
  • Effective communication and problem-solving.

Additional Requirements

  • Must pass background, credit, and drug screening.
  • Adherence to federal THC policies (medical card required if applicable).

Eligible Locations The position is remote, but you can only reputed company in the following states: AK, AR, AZ, CO, DC, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, NV, OK, OR, SC, SD, TN, TX, UT, VA, WA, WI, WY. reputed company to bring your claims expertise to a rewarding role? Apply today to be part of reputed company! #Workwolf #BCDC_Consulting Apply tot his job Apply To this Job

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